GQ Corner
Q. Claimant lives in Texas, but works across the border in Juarez, Mexico, where the injury occurred. He was hired in Texas. His injury would be compensable if it had occurred in Texas. Is the carrier liable even though the employer has coverage in Texas only ?
A. It depends. If he was injured not later than one year after the date of hire, then the claimant is covered. If he was injured more than a year after the date of hire, then in the 12 months preceding his date of injury, he must have worked in Texas at least 10 working days in order to be covered. See Sec. 406.071.
Q. Treating doctor provided claimant with a 1% in a certification of MMI/IR. Claimant got a lawyer who requested a designated doctor, but claimant no showed. The attorney then sent claimant to a chiropractor for an alternate certification of MMI/IR, which the claimant apparently attended. The attorney then called me and is requesting payment for the chiropractor. I told him I’m not going to pay it—is that correct?
A: You are correct that you do not owe for an appointment for an alternate MMI/IR certification. Texas Labor Code Section 408.0041(h) states the carrier pays for an examination to determine MMI/IR from the treating doctor or a referral if the designated doctor’s certification is the first evaluation of MMI/IR and the claimant is not satisfied by the designated doctor’s opinion. Since neither of those criteria are met, you are correct you are not liable for the chiropractor’s bill for performing an MMI/IR evaluation.
FOLIO
